tbuckley/cabot-search huggingface dataset:
Chronic cor pulmonale. Etiology and management
Authors: H. I. Palevsky
Journal: JAMA (1990)

Cor pulmonale is right ventricular enlargement secondary to pulmonary hypertension. Although most often caused by parenchymal lung disease, derangements of the ventilatory drive, the respiratory pumping mechanism, or the pulmonary vascular bed may also result in right ventricular hypertrophy and dilatation. Arterial hypoxemia (and resultant polycythemia), hypercapnia, and respiratory acidosis all contribute to the increased afterload on the right ventricle. Diagnosis is often difficult, since pulmonary vascular disease, pulmonary hypertension, and cor pulmonale have few specific manifestations, especially early in their evolution. Treatment is primarily directed at the underlying pulmonary or ventilatory disorder, rather than at the right ventricular failure per se. Supplemental oxygen is essential to avoid hypoxia; corticosteroids, anticoagulants, vasodilators, and other specific therapies are used as indicated to treat the underlying pulmonary disorders. When medical therapies fail, lung or heart-lung transplantation has become a possibility for selected patients. (<i>JAMA</i>. 1990;263:2347-2353)
用于诊断疥疮感染的巢式 PCR
Authors: J.E. Hahm, C.W. Kim, S.S. Kim
Journal: British Journal of Dermatology (2018)

疥疮是一种高度传染性、非常瘙痒的皮肤螨虫感染,这种螨虫称为疥螨。虽然它在发展中国家更为普遍,但在老年护理机构中的爆发对发达国家来说已成为一个日益严重的问题。矿物油检查,包括用矿物油轻轻刮擦患者皮肤,将刮屑转移到载玻片上,然后用显微镜识别螨虫或虫卵,被认为是诊断疥疮的金标准,但这并不总是准确的。这项来自韩国的研究旨在提高疥疮实验室诊断的准确性。作者测试了一种不同的检测疥疮的方法,称为巢式聚合酶链反应 (PCR),并将巢式 PCR 结果与常规诊断方法的结果进行比较,以确定哪种方法更为准确。巢式 PCR 是一种在试管中生成特定 DNA 区域的大量拷贝的方法,从而能够寻找引起疥疮的螨虫的 DNA。临床疑似疥疮患者接受了矿物油检查。当在显微镜下发现螨虫或虫卵时,对疥疮的诊断即为阳性,然后将患者指定为“显微镜阳性”。“显微镜阴性”组中的患者呈现阴性显微镜结果,这意味着在显微镜下未见到螨虫或虫卵。从两组中收集皮肤刮屑进行 PCR。在总共 63 个样本中,28 个为显微镜阳性,35 个为阴性。所有显微镜证实的疥疮病例均为巢式 PCR 阳性。在显微镜阴性的患者中,在 9 个样本中检测出了疥螨的 DNA。这意味着在使用常规检测方法在显微镜下未发现螨虫或虫卵的 35 个病例中,有 9 个病例使用巢式 PCR 确实发现了螨虫的 DNA。如果认为巢式 PCR 的灵敏度(准确度)为 100%,则显微镜的灵敏度为 75.68%。因此,巢式 PCR 可以成功地用作诊断疑似疥疮病例的替代方法。此外,可以在感染广泛扩散之前启动控制措施和治疗,从而将爆发风险降至最低。
New Uses Found for Scan Technique
Journal: JAMA (1966)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
The Metabolic Functions of Vitamin B<sub>12</sub>
Authors: William S. Beck
Journal: New England Journal of Medicine (1962)

Provocative but Unexplained Features of the Deficiency SyndromeOf the many metabolic and clinical aberrations that have been reported in animals and human beings deficient in vitamin B125–8 most shed little light on the mode of vitamin B12 action (for example, weight loss). The three phenomena to be discussed here, though lacking final explanations, could conceivably have been predicted from the results presented in earlier sections of this report. Moreover, they have the virtue of suggesting some useful experiments.Megaloblast FormationThe megaloblast is a morphologic entity characterized by large cell size, increased ratio of cytoplasmic to nuclear . . .
Diurnal fluctuations of portal and systemic hemodynamic parameters in patients with cirrhosis
Authors: D Alvarez
Journal: Hepatology (1994)

A close temporal relationship between higher levels of portal pressure during the night and the peak incidence of acute variceal bleeding has recently been demonstrated in patients with cirrhosis. Because hemodynamic changes may have a role in triggering this hemorrhagic episode, we measured systemic and portal hemodynamic parameters at 4-hr intervals for 24 hr in 12 cirrhotic patients. These results were compared with those obtained in eight healthy subjects. Cardiac output, femoral and portal blood flows were measured by Doppler technique. In cirrhotic patients, heart rate and mean arterial pressure remained constant throughout the whole study period. A marked and significant increase in portal blood flow (917 ± 248 ml/min) (mean ± S.D.) as compared with mesor values (649 ± 114 ml/min, p < 0.001) was observed at midnight. This effect was accompanied by a mild but significant rise of cardiac output (from 6.5 ± 0.7 to 6.8 ± 0.7 l/min, p < 0.01) at 2400 hr. A significant correlation between both hemodynamic parameters was found (r = 0.78, p < 0.01). Cosinor analysis showed a significant (p < 0.05) circadian rhythm for both portal blood flow and cardiac output with an acrophase at 0050 hr. In the healthy subjects group, a significant decrease of mean arterial pressure and heart rate was observed at 2400 hr. Cosinor analysis confirmed the presence of significant rhythm for both hemodynamic parameters. In contrast with cirrhotic patients, no significant changes were observed in portal blood flow and cardiac output in healthy subjects. Our results show that in patients with cirrhosis, maximal increases in portal blood flow occur at night. The circadian variation of portal blood flow could have important implications in the management of these patients. (Hepatology 1994;20:1198–1203).
Vasopressin Deficiency and Pressor Hypersensitivity In Hemodynamically Unstable Organ Donors
Authors: Jonathan M. Chen, Suzanne Cullinane, Talia B. Spanier, John H. Artrip, Ranjit John, Niloo M. Edwards, Mehmet C. Oz, Donald W. Landry
Journal: Circulation (1999)

Background —Solid organ donors often develop hypotension due to vasodilation, and recently we observed that a variety of vasodilatory states are characterized by vasopressin deficiency and hypersensitivity. Thus, we investigated the prevalence of vasopressin deficiency in hypotensive solid organ donors without clinical evidence of diabetes insipidus; we also investigated the vasopressor effect of vasopressin replacement in hypotensive donors. Methods and Results —Fifty organ donors were evaluated for hemodynamic instability, (mean arterial pressure [MAP]≤ 70 mm Hg despite the use of catecholamine vasopressors), and in those unstable donors who were not already receiving exogenous vasopressin, low-dose vasopressin was administered as a continuous infusion (0.04 to 0.1 U/min). MAP, catecholamine requirements, serum vasopressin, and serum osmolality were obtained before and after vasopressin administration. Ten patients meeting the enrollment criteria received vasopressin and MAP increased from 72.2±3.5 to 89.8±4.2 mm Hg, ( P &lt;0.05), allowing for complete discontinuation of catecholamine pressors in 4 (40%) patients and a decrement in pressor dose in 4 (40%). Plasma vasopressin levels (2.9±0.8 pg/mL) were low for the degree of hypotension. Conclusions —Hemodynamically unstable organ donors without clinically apparent diabetes insipidus display a defect in the baroreflex-mediated secretion of vasopressin. In these patients, low-dose vasopressin significantly increases blood pressure with a pressor response sufficient to reduce catecholamine administration.
A Correction to the Report Titled: “Short-Term Monotherapy in HIV-Infected Patients with a Virus Entry Inhibitor Against the gp41 Fusion Peptide” by W.-G. Forssmann, Y.-H. The, M. Stoll, K. Adermann, U. Albrecht, K. Barlos, A. Busmann, A. Canales-Mayordomo, G. Giménez-Gallego, J. Hirsch, J. Jiménez-Barbero, D. Myer-Olson, J. Münch, J. Pérez-Castells, L. Ständker, F. Kirchhoff, R. E. Schmidt
Journal: Science Translational Medicine (2012)
Contact tracing and the control of human immunodeficiency virus infection
Authors: G. W. Rutherford
Journal: JAMA (1988)

Contact tracing, the practice of identifying and treating individuals exposed to certain communicable diseases, has long been a bulwark of public health practice in the United States.<sup>1,2</sup>Originally proposed in 1937 by Surgeon General Thomas Parran for the control of syphilis, it became firmly established in syphilis control programs by the late 1940s.<sup>3-6</sup>The central strategy in syphilis contact tracing was the early identification and treatment, first with arsphenamine and later with See also p 3563. penicillin, of asymptomatic individuals who had been sexually exposed to the disease and were therefore at risk of being infected and infective.<sup>5</sup>By tracing chains of syphilis transmission from a patient with known infection, and by treating all potentially infected contacts, transmission could be interrupted. The success of contact tracing was perhaps best seen in the declining prevalence of syphilis in the 1950s and in the control of localized outbreaks of
Risque de cancer colorectal après une coloscopie négative chez les patients à risque bas à modéré: impact d’une coloscopie à 10 ans
Journal: Endoscopy (2017)

En cas de polype à bas risque, en l’absence de facteur de risque de cancer colorectal (CCR) et d’antécédent d’adénome, après un contrôle de coloscopie négatif, l’HAS en 2013 recommande un contrôle à 10 ans puis un arrêt de la surveillance avec un retour au dépistage organisé du CCR par test immunologique fécal (TIF). L’intérêt de ce contrôle à 10 ans repose sur une série rétrospective cas-témoins montrant qu’une coloscopie normale diminue le risque de CCR à 10 ans. Un essai randomisé montre un bénéfice de la rectosigmoïdoscopie pour éviter le CCR et diminuer la mortalité relative au CCR. Mais peu d’études ont évalué l’impact de cette coloscopie à 10 ans.
Consent: informed, implied, and deferred
Journal: JAMA (1986)

<h3>To the Editor.—</h3> Abramson et al<sup>1</sup>are to be congratulated for merging the legal doctrines of informed consent with the medical realities of research in the critically ill patient. They have thereby formulated a practical solution to a difficult problem. The institutional review boards (IRBs) of the various hospitals in the study should also be commended for their acceptance of this sorely needed concept. The authors have noted federal regulations that foster research and at the same time protect individuals. Unfortunately, despite these guidelines many IRBs and attorneys are reluctant to allow research to occur without the actual consent of the patient himself. Some people view research as a risk rather than as a benefit for subjects, especially if the subject has a 50% chance of receiving a placebo. Often forgotten is the Hawthorne effect-the fact that one may benefit solely by being part of a research project.<sup>2</sup>
Role of RANK ligand in mediating increased bone resorption in early postmenopausal women
Authors: Guitty Eghbali-Fatourechi, Sundeep Khosla, Arunik Sanyal, William J. Boyle, David L. Lacey, B. Lawrence Riggs
Journal: Journal of Clinical Investigation (2003)

Studies in rodents have implicated various cytokines as paracrine mediators of increased osteoclastogenesis during estrogen deficiency, but increases in RANKL, the final effector of osteoclastogenesis, have not been demonstrated. Thus, we isolated bone marrow mononuclear cells expressing RANKL on their surfaces by two-color flow cytometry using FITC-conjugated osteoprotegerin-Fc (OPG-Fc-FITC) as a probe. The cells were characterized as preosteoblastic marrow stromal cells (MSCs), T lymphocytes, or B lymphocytes by using Ab’s against bone alkaline phosphatase (BAP), CD3, and CD20, respectively, in 12 premenopausal women (Group A), 12 early postmenopausal women (Group B), and 12 age-matched, estrogen-treated postmenopausal women (Group C). Fluorescence intensity of OPG-Fc-FITC, an index of the surface concentration of RANKL per cell, was increased in Group B over Groups A and C by two- to threefold for MSCs, T cells, B cells, and total RANKL-expressing cells. Moreover, in the merged groups, RANKL expression per cell correlated directly with the bone resorption markers, serum C-terminal telopeptide of type I collagen and urine N-telopeptide of type I collagen, in all three cell types and inversely with serum 17β-estradiol for total RANKL-expressing cells. The data suggest that upregulation of RANKL on bone marrow cells is an important determinant of increased bone resorption induced by estrogen deficiency.
Urologische Operationslehre.
Journal: JAMA (1925)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Health and Hygiene for the Household
Journal: JAMA (1901)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Evaluation of Vacuum Extractor Used in Second Stage of Labor
Journal: JAMA (1963)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
APPARATUS FOR CONTINUOUS INTRAVENOUS ADMINISTRATION OF FLUIDS BY WHICH THE RATE OF FLOW MAY BE EASILY DETERMINED AND CONTROLLED
Journal: JAMA (1921)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
A FATAL RESULT FOLLOWING A HYPODERMIC INJECTION, BEHRING'S ANTITOXIN BEING THE INJECTED REMEDY.
Journal: JAMA (1895)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Physical Therapy
Journal: JAMA (1926)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
QUARTERLY SURVEY OF DERMATOLOGICAL LITERATURE
Journal: British Journal of Dermatology (1919)

British Journal of DermatologyVolume 31, Issue 4 p. 211-217 QUARTERLY SURVEY OF DERMATOLOGICAL LITERATURE First published: October 1919 https://doi.org/10.1111/j.1365-2133.1919.tb09716.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume31, Issue4October 1919Pages 211-217 RelatedInformation
Chemotherapy use for hormone receptor-positive, node-negative breast cancer
Authors: M. J. Hassett, M. E. Hughes, J. C. Niland, S. B. Edge, R. L. Theriault, Y. Wong, J. Wilson, B. W. Carter, D. W. Blayney, J. C. Weeks
Journal: Journal of Clinical Oncology (2007)

11004 Background: High quality evidence has shown that adjuvant chemotherapy (chemo) improves survival for hormone receptor- positive, node negative breast cancer measuring &gt;1 cm (H+/N-/T&gt;1cm BC). Since 2002 National Comprehensive Cancer Network (NCCN) guidelines have recommended chemo for this group. Because the benefit from chemo in this situation is modest there is debate regarding which women, if any, can forego chemo. We describe trends in chemo use and identify factors associated with not receiving chemo for H+/N-/T&gt;1cm BC. Methods: We identified women less than 70 years old with H+/N-/T&gt;1cm BC diagnosed 1997–2004 and treated at 8 NCCN institutions. We analyzed the frequency of chemo use on a yearly basis (chi square). A multivariable logistic regression model assessed the relationship between likelihood of not receiving chemo and year of diagnosis, institution, tumor size, histologic characteristics and socio- demographic variables. We incorporated interaction terms to explore how chemo use varied over time and between institutions. Results: Of 3190 women with H+/N-/T&gt;1cm BC, 56% received chemo. Chemo use was less common for 1.1–2 cm than for &gt;2 cm tumors (48 vs. 83%; p&lt;.01). There was no significant change in chemo use over time, but there was significant variability among institutions (range 47–65%; p&lt;.01). On multivariable analysis, predictors independently associated with not receiving chemo included lower histologic/nuclear grade, non-ductal/lobular histology, absence of lymphovascular invasion or HER2 overexpression, and older age (p&lt;.01 for all). The interaction between institution and year of diagnosis was also significant (p&lt;.01). Over the 2 years following the NCCN guideline’s definitive recommendation for chemo in 2002, the relative change in institutional chemo use ranged from a 25% decrease to a 28% increase. Conclusions: Many women did not receive chemo despite clinical trial evidence. Providers considered molecular features, tumor size and patient age when deciding who should receive chemo. While overall trends in chemo use did not change, use appeared to increase at some institutions and decreased at others after the 2002 guideline recommendation for chemo. This suggests a lack of consensus at NCCN institutions regarding when to administer chemo for H+/N-/T&gt;1cm BC. No significant financial relationships to disclose.